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Tobacco consumption: Stubbing it out

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The roadmap for India’s tobacco control program lies in more stringent laws and higher taxes to wean the public from the pernicious habit    

By Shoba John

Come November, government delegations from over 150 countries will descend on Delhi to attend the Seventh Conference of Parties (COP) of the Framework Convention on Tobacco Control (FCTC). One of the most rapidly and widely embraced treaties under the UN system, it currently has 180 governments as Parties covering nearly 90 percent of the world’s population. As the treaty enters its second decade, India will be hosting the biannual gathering of its Parties, which decides the future direction of global tobacco control.

This is significant given that India is the second largest producer and consumer of tobacco, next only to China. Tobacco causes one million deaths in the country every year. Not to mention the related disability and productivity loss. The direct and indirect costs of treating tobacco-related diseases in the country were estimated to be Rs 1,04,500 crore in 2011 (1.16 percent of the GDP). This was about six times the central excise revenue from all tobacco products that year. That implies a huge net drain on the country’s economy and resultant threat to its development.

TOBACCO CONTROL EFFORTS

This drain on human and economic resources alone gives enough reasons for India to take serious steps to curb the tobacco epidemic. India’s tobacco control efforts, in fact, paralleled the development of the FCTC. Even as India proactively contributed to the international negotiations, the momentum from them propelled the country’s own comprehensive tobacco control law, the Cigarettes and Other Tobacco Products Act (COTPA), 2003.

Thanks to the Cigarettes and Other Tobacco Products Act (COTPA), 2003, one can now breathe easy in public places and public transport. Tobacco packs now carry visible, picture-based health warnings instead of the rather ambiguous line, “Smoking is injurious to health”. 

Thanks to this law, one can now breathe easy in public places, including in restaurants, workplaces, stadia, bus stops and public transport. The ad ban in the law brought down tobacco billboards and hoardings, promotion in mainstream media as also tobacco sponsorship such as of the country’s cricket team. Tobacco packs now carry visible, picture-based health warnings instead of the rather ambiguous line, “Smoking is injurious to health”.

India is among the few countries that have banned the sale of tobacco by minors in addition to sale of the product to minors and near educational institutions. Tobacco control has begun to find reflection in policies of non-health sectors. The ministry of environment banned plastic sachets for tobacco packs under its Plastic Waste Management Rules, 2016. Similarly, Juvenile Justice (Care and Protection of Children) Act 2015 now deters giving tobacco to minors with stringent punishment.

Under the same law, India introduced restrictions on the promotion of tobacco through display of tobacco products or their use in movies and television. Given the broad viewership of Indian movies across the world, this initiative has the potential to become India’s concrete contribution to reducing exposure to tobacco promotions beyond its borders. Meanwhile, the National Tobacco Control Programme, launched in 2007-08, is envisaged to cover the entire nation in the current Five Year Plan. State Tobacco Control Cells, inspired by the program, are evolving to be the nerve centers for sub-national tobacco control enforcement, health promotion and cessation efforts.

INCREASED ACTION

Indeed, recent years have seen increasing action by states to turn the tide against tobacco. Except for a state or two, the rest have progressively banned various smokeless forms of tobacco. Punjab and Maharashtra have set the ban on e-cigarettes rolling. Punjab also introduced first-in-the country ban on the sale of loose cigarettes (single sticks) and tobacco in early 2015. Himachal Pradesh followed suit on October 5, further requiring licensing of tobacco retailing. Several states like Assam, Kerala and Tamil Nadu have been raising VAT on tobacco products. All these have been efforts to make them expensive and out of reach, particularly for vulnerable groups such as children and youth.

Doctors with an effigy made from tobacco pouches and cigarette packets during an awareness campaign on “World No Tobacco Day” in Patna. Photo: UNI 
Doctors with an effigy made from tobacco pouches and cigarette packets during an awareness campaign on “World No Tobacco Day” in Patna. Photo: UNI 

Last year witnessed tobacco control emerging from the shadows to the mainstream political and public discourse. Tobacco came to be the topic of discussion in prime time debates. “Tobacco Gate” brought to light the blatant conflict of interest of lawmakers with tobacco interests deciding on tobacco warnings in parliamentary committees. Even the more recent Goods and Services Tax (GST) debates saw political parties taking cautious and considered views on tobacco, and rightly so.

FUTURE PLANNING

The courts have been the harbingers of tobacco control in the country since the start of the century and continue to uphold sound policies over limited business interest. Despite intense litigation by tobacco companies, a Supreme Court order has strengthened the ban on smokeless tobacco in September 2016, whereas it refused to stay the implementation of pictorial warnings on tobacco packs.

Despite intense litigation by tobacco companies, a Supreme Court order has strengthened the ban on smokeless tobacco in September 2016, whereas it refused to stay the implementation of pictorial warnings on tobacco packs.

Tobacco control efforts take time to show results. Meanwhile, tobacco consumption levels are increasing unabated, and more so among vulnerable populations. Over one third of Indians consume tobacco in one form or the other (Global Adult Tobacco Survey, 2010). Smoking among women doubled during 2005-2010. Tobacco use in India is also found to increase with decrease in income and education levels, with the poor more susceptible to the habit.

This calls for expanding the scope of current laws, improving their enforcement and exploring evidence-based innovative policies backed by effective risk communication to get ahead of the tobacco curve. Here are some suggestions on what ought to be done:

Institute high tobacco taxes under GST: Tobacco taxes are considered to be the single most effective measure to reduce tobacco use. A 10 percent increase in tax is projected to reduce consumption by 2-8 percent in developing countries. The on-going discussions in the country around the GST law present an opportunity to ensure that tobacco tax serves its public health objective, alongside revenue collection.

Under the GST regime, chief economic advisor Arvind Subramaniam has recommended a 40 percent tax on demerit goods like tobacco (which translates to about 28 percent of the retail price). Notably, WHO recommends the taxes on tobacco to be at least 70 percent of the retail price for it to meet its health objectives. These taxes can also provide a sustainable source of revenue for various developmental efforts, including tobacco control.

Improve the current law: COTPA has run its course for over a decade and needs urgent improvements. Public areas and transport where people gather for considerable time such as cars, work sites, living units with shared spaces and markets need to become 100 percent smoke-free. The designated smoking areas allowed for large restaurants in the current law is not only discriminatory to smaller eateries (with under 30 seats), but normalize tobacco use and make enforcement challenging—they need to go! Tobacco displays and advertising at points of sale and emerging media platforms need to be prohibited, given how they expose children and youth to tobacco promotion. Several countries have embarked on the path of plain packaging to limit tobacco promotions on packs and use it as a risk communication tool instead. It is time also for India to consider plain packs, alongside ban on single unit (sticks/pouches) sales.

Enhance action on smokeless tobacco and bidis: India accounts for 74 percent of the 300 million global smokeless tobacco users (NCI and CDC Smokeless tobacco report).  Sadly, this makes it the oral cancer capital of the world and calls for policies specifically targeted to reduce smokeless tobacco use and supply. While individual states have initiated action under the Food Safety Rules, it would take a nation-wide control on the manufacture and sale to move the country towards a tobacco-free future. Bidis, used by over 60 percent of the country’s smokers, mostly escape the tax net through various loopholes. Economists suggest that increasing bidi taxes from the current 9 percent to 40 percent of retail price can help avert up to 15.5 million premature deaths caused by its smoking. This, of course, needs to be augmented by continuing the efforts to reduce cigarette consumption.

Protect policies from tobacco industry influence: The FCTC (Article 5.3) requires its parties to protect tobacco control policies from tobacco interests. Tobacco industry partnerships with various sectors within the government raise serious concerns for tobacco control in the country. An example being the partnership that International Tax and Investment Center, a group supported by tobacco transnationals, sought with India’s Ministry of Finance to host its Annual Asia Pacific Tax Forum. Timely civil society action ensured that elected officials and World Bank refrained from participating in this event.

Similarly, in 2010, the Karnataka High Court ordered the Tobacco Board, a government body under the ministry of commerce, to withdraw co-sponsoring the “greatest tobacco talk show on earth”—the Global Tobacco Networking Forum 2010.  A draft code of conduct for government officials in dealing with the tobacco industry was discussed during the hearing. India needs to urgently develop due diligence procedures and clear conflict of interest policies for all wings of the government in the interest of its people’s health.

Several high-income countries have managed to reduce their tobacco prevalence through effective polices over the years. Some like Singapore, Ireland and New Zealand are now gearing up for a tobacco-free scenario through concrete measures. Last year, the UN Sustainable Development Goals set a target of 30 percent relative reduction in mortality from non-communicable diseases (NCDs) by 2030. Tobacco being a major risk factor for NCDs, achieving this target requires high tobacco-burden countries like India to accelerate their tobacco control efforts. This calls for an end-game plan for tobacco control in India.

Visible public support, high-level political will, coordination across ministries, decisive policies, robust enforcement machinery and an active civil society can propel the country in this direction. The Seventh Conference of Parties could provide the much-needed momentum to leap into the next phase in tobacco control in India.

—The writer is former Chair of the Framework Convention Alliance, an international civil society coalition that advocates effective implementation of the Framework Convention on Tobacco Control




 

Lead picture: (Right) Members of an NGO take part in a rally to mark “World No Tobacco Day” in Kolkata. Photo: UNI

 

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